A 34-year-old female software engineer self-refers for evaluation after reading about autism in women. She reports a lifelong history of difficulty understanding social cues, maintaining reciprocal conversations, and making friends. She describes developing elaborate mental scripts for social interactions and feeling exhausted after socializing, which she calls 'masking.' She has intense, focused interests in specific topics that dominate her free time, is highly sensitive to fluorescent lighting and clothing textures, and adheres to rigid daily routines with significant distress when they are disrupted. She performed well academically but has been fired from two jobs for being perceived as 'blunt' and 'difficult.' She has prior diagnoses of social anxiety disorder and ADHD, neither of which responded to standard treatments.